Provider Demographics
NPI:1407920457
Name:DAHLKE, JANE BRUSH (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:BRUSH
Last Name:DAHLKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:CAROLYN
Other - Middle Name:A
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OFFICE MANAGER
Mailing Address - Street 1:10815 ELM STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-4819
Mailing Address - Country:US
Mailing Address - Phone:402-397-6160
Mailing Address - Fax:402-397-5646
Practice Address - Street 1:10815 ELM STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-4819
Practice Address - Country:US
Practice Address - Phone:402-397-6160
Practice Address - Fax:402-397-5646
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2010-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE126592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47074890800Medicaid
B67762Medicare UPIN
NE47074890800Medicaid